Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

62 Acute Respiratory Failure/Monitoring Adenocarcinoma/Ampulla of Vater

■Hypercarbia: Somnolence, narcosis, respiratory acidosis, myocar-

dial depression

Prognosis

■Depends on underlying cause

■1-year survival after acute respiratory failure 28–72%

■Mortality from ARDS is 40–50%

Adenocarcinoma of the Ampulla of Vater....................

SUSAN A. CUMMINGS, MD

history & physical

Risk Factors

■slowly growing; high cure rate if resected; thus important to distin-

guish from cholangiocarcinoma and pancreatic cancer

■adenoma of the ampulla

■familial polyposis and Gardner’s syndrome

Signs & Symptoms

■same as cholangiocarcinoma with jaundice and pruritus

■acholic stools

■silver bullet stool (acholic stool and blood)

■melena

■cholangitis

tests

Routine Tests

■high alkaline phosphatase and bilirubin

■occasional iron deficiency anemia

Special Tests

■Ultrasound and CT

➣dilated intra and extrahepatic bile ducts

■ERCP

➣mass at ampulla; biopsy yield may be increased with sphinctero-

tomy

differential diagnosis

■pancreatic carcionoma

■distal cholangiocarcinoma

■duodenal carcinoma